Effects of gabapentin following minimally invasive repair of pectus excavatum with intercostal nerve cryoablation (MIRPE-INC).

Purpose: Gabapentin is used for treating postoperative pain and preventing neuropathic pain. We aimed to examine the effects of gabapentin on opioid use and neuropathic pain following minimally invasive repair of pectus excavatum with intercostal nerve cryoablation (MIRPE-INC).

Methods: A prospective comparison study was conducted among patients ≤21 years old undergoing MIRPE-ICN. Patients were grouped based on perioperative gabapentin use (gabapentin beginning 2 weeks prior to MIRPE-INC from March 2021 to December 2022 and no-gabapentin cohorts from June 2023 to June 2024). Participants underwent chest wall sensory examination and neuropathic pain screening (S-LANSS) pre-MIRPE and post-MIRPE (postoperative day 1 (POD1), 2 weeks, 2 months). S-LANSS score ≥12 was suggestive of neuropathic pain. Additionally, inpatient opioid use, inpatient pain scores, and length of stay (LOS) were recorded. Outcomes were compared between cohorts.

Results: Of the 112 patients enrolled, 39 received perioperative gabapentin and 73 did not. Age, Haller index, correction index, and BMI were similar between cohorts. The gabapentin cohort was less likely to have neuropathic pain symptoms (S-LANNS ≥12) on POD1 (11.4 % vs 31.9 %, p = 0.023). At 2 weeks and 2 months postoperatively, the frequency of s-LANSS scores ≥12 was similar between treatment groups, as was the incidence of hyperesthesia on chest wall sensory examination. Total inpatient oral morphine equivalents were similar between cohorts.

Conclusions: Perioperative gabapentin use was associated with a decreased incidence of neuropathic pain symptoms immediately post-MIRPE-INC but did not decrease perioperative opioid use or LOS. Gabapentin did not decrease neuropathic pain symptoms outside the immediate perioperative period.

Level Of Evidence: Level 2.